Religion and Spiritual Health in Patients With and Without Depression Receiving Hemodialysis: A Cross-Sectional Correlational Study.

BACKGROUND: Hemodialysis is the most common therapy for managing patients with end-stage renal disease. Depression is one of the most common psychological problems faced by dialysis patients, and there is limited research on the influences of religion and spirituality on dialysis patients. PURPOSE: This study was designed to compare religion and spiritual health status between hemodialysis patients with and without depressive symptoms. METHODS: A cross-sectional survey was conducted on 137 hemodialysis patients living in Taiwan. The self-report instruments used included the Religious Beliefs Scale, Spiritual Health Scale-Short Form, and Beck Depression Inventory-II. Data were analyzed using t test, chi-square test, point-biserial correlation of variance, and logistic regression. RESULTS: Most (63.5%) of the participants were classified with depression, of which most were male (70.1%), older (mean = 62.56 years), and unemployed (73.6%) and had less formal education. Fifty-two of the participants with depression had a 1- to 5-year duration of hemodialysis, whereas the nondepressed group had a higher mean score for number of religious activities, positive religious beliefs, and total score for spiritual health. Logistic regression showed an increased odds ratio ( OR ) of depression for participants with a duration of hemodialysis of 1-5 years ( OR = 3.64, 95% CI [1.01, 13.15]). Participants with higher scores for spiritual health had a lower risk of depression ( OR = 0.82, 95% CI [0.75, 0.90]), indicating a positive association between spiritual health and lower depression risk. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The prevalence rate of depression in hemodialysis patients is higher than that in the general population. Providing screenings for spiritual health and depression as part of routine medical care for hemodialysis patients is recommended to detect spiritual distress and depression early.

[Advance Decision Behavioral Intention and Related Factors in Adults Living in the Community].

BACKGROUND: Improvements in medical science and technology have increased the average number of years that older adults survive with impaired quality of life. Understanding behavioral intentions and related factors affecting advance decision (AD) decision-making can help medical professionals improve the decision-making ability of patients, allowing patients and their family members to make better medical decisions that reduce ineffective medical treatments, improve quality of life, and facilitate a good death. PURPOSE: This study was developed to explore behavioral intentions and related factors during the process of AD decision-making among community adults. METHODS: A cross-sectional study design was used in this study. The knowledge, attitudes, and behavioral intentions regarding AD decisions, spiritual health, and social support were measured in a convenience sample using physical or internet-based questionnaires. Data were analyzed in SPSS 21.0 using descriptive and independent samples t-tests, one-way ANOVA, Pearson correlation, and multiple regression analysis. RESULTS: Three hundred and seventy-seven community adults participated in this research (50.57 years old, SD = 13.39; 58.4% female). The average level of AD-related behavioral intention was found to be high, with high numbers of participants indicating that they would refuse endotracheal intubation (4.13, SD = 0.92), extracorporeal membrane oxygenation (4.09, SD = 0.95), extracorporeal heart massage (4.08, SD = 0.95), and defibrillation (4.08, SD = 0.98) if they were in a permanent vegetative state in the future. The important predictors of AD behavioral intention included gender, written expression of end-of-life medical decision-making, participation in the patient self-rights law and advance decision publicity lectures, having an advance decision attitude, and social support (R2 = 40.1%, p < .001). CONCLUSIONS / IMPLICATIONS FOR PRACTICE: A high level of AD-related behavioral intention was found in the sample and several important factors that influence related behaviors were identified. These results provide an important reference for related public policymakers to increase the percentage of older patients participating in advance directive decision-making.

Mediating role of spirituality on the relationships between posttraumatic stress and posttraumatic growth among patients with cancer: A cross-sectional study.

Objective: This study explores the impact of posttraumatic stress (PTS) on posttraumatic growth (PTG) and verifies the mediating effect of spirituality among patients with cancer. Methods: This study used a cross-sectional correlational design. This study surveyed 141 hospitalized patients over 20 years of age diagnosed with cancer. Participants were recruited by convenience sampling from a regional hospital in Taiwan. Data were collected from January to April 2021. Measurements included sociodemographic and disease-related information and data from the following self-report questionnaires: Posttraumatic Stress Reaction Index-Short Form, Posttraumatic Growth Inventory, and Spiritual Health Scale-Short Form. Structural equation modeling and bootstrapping were used to analyze the mediating effect of spiritual health on PTS and PTG. Results: PTS and spirituality were negatively correlated, spirituality, and PTG were positively correlated, and PTS had no correlation with PTG. Spirituality fully presented a mediating role between PTS and PTG. Conclusions: Patients' spirituality should be regarded as an important variable that can impact stress appraisal and improve the patient's PTG when a diagnosis of cancer is received. Assessing spiritual health at regular intervals and integrating spiritual care with clinical care could decrease PTS and improve PTG for patients with cancer.

Development and validation of the oral presentation evaluation scale (OPES) for nursing students.

BACKGROUND: Oral presentations are an important educational component for nursing students and nursing educators need to provide students with an assessment of presentations as feedback for improving this skill. However, there are no reliable validated tools available for objective evaluations of presentations. We aimed to develop and validate an oral presentation evaluation scale (OPES) for nursing students when learning effective oral presentations skills and could be used by students to self-rate their own performance, and potentially in the future for educators to assess student presentations. METHODS: The self-report OPES was developed using 28 items generated from a review of the literature about oral presentations and with qualitative face-to-face interviews with university oral presentation tutors and nursing students. Evidence for the internal structure of the 28-item scale was conducted with exploratory and confirmatory factor analysis (EFA and CFA, respectively), and internal consistency. Relationships with Personal Report of Communication Apprehension and Self-Perceived Communication Competence to conduct the relationships with other variables evidence. RESULTS: Nursing students' (n = 325) responses to the scale provided the data for the EFA, which resulted in three factors: accuracy of content, effective communication, and clarity of speech. These factors explained 64.75% of the total variance. Eight items were dropped from the original item pool. The Cronbach's α value was .94 for the total scale and ranged from .84 to .93 for the three factors. The internal structure evidence was examined with CFA using data from a second group of 325 students, and an additional five items were deleted. Except for the adjusted goodness of fit, fit indices of the model were acceptable, which was below the minimum criteria. The final 15-item OPES was significantly correlated with the students' scores for the Personal Report of Communication Apprehension scale (r = -.51, p < .001) and Self-Perceived Communication Competence Scale (r = .45, p < .001), indicating excellent evidence of the relationships to other variables with other self-report assessments of communication. CONCLUSIONS: The OPES could be adopted as a self-assessment instrument for nursing students when learning oral presentation skills. Further studies are needed to determine if the OPES is a valid instrument for nursing educators' objective evaluations of student presentations across nursing programs.

A preliminary study of current situation and competences of doctoral nursing education in Taiwan: A multi-methods research design.

AIM: To explore the status and overall competency of Taiwan's doctoral nursing programs. BACKGROUND: Taiwan has 11 universities offer doctoral degree programs in nursing from 1997 to 2020. As the demand for educators of higher nursing education increases, whether the nursing talent requirements have been satisfactorily fulfilled. DESIGN: A two-stage data collection based on a multi-methods survey was conducted. METHODS: The first stage from December 2017 to the end of December 2019, involved collecting admission brochures for 12 doctoral nursing programs provided by 11 universities and 14 Internet databases. In the second stage, convenience sampling was performed to recruit 115 graduates of national doctoral nursing programs to collect data through a self-administered questionnaire online survey from July to the end of September 2018. RESULTS: A systematic review of the vision and core competencies of each university revealed a general emphasis on nursing knowledge, research, leadership, international perspective and competence, innovation, social practice and policy. More specifically, universities aim to cultivate five core competencies in students, for example, nursing knowledge, scientific and innovative research capabilities and participation in the formulation and promotion of nursing policies. Of the 115 graduates of national doctoral nursing programs surveyed, the online questionnaire revealed that more than half of the respondents were aged 41-50 years (n = 62, 53.9%), 81.8% occupied a teaching position and most had 2.4-9.8 years of study in the program (mean = 6.09 ± 1.81 years). Respondents who completed a doctoral nursing program in Taiwan could learn orderly teaching, research and leadership capabilities with scored 4.12, 4.11 and 3.65, respectively. CONCLUSIONS: The overall orientation of the doctoral nursing programs in Taiwan aligns approximately with global trends in nursing. This study suggests that international and national resources should be incorporated into the cultivation of various competencies and curriculum quality control; moreover, industry, academia and the government should hold regular meetings to formulate suitable evaluation mechanisms.

The relationship between spiritual health, health-promoting behaviors, depression and resilience: A longitudinal study of new nurses.

AIM: To determine if levels of spiritual health, health-promoting behaviors, depressive symptoms and resilience change over time and determine if any variables have an impact on resilience among new nurses. BACKGROUND: Nurses provide patients with medical care and emotional support in high-stress environments. Resilience is a characteristic that allows one to adjust to these adverse situations. Resilience can help new nurses withstand the emotional stress of the workplace and improve nurse retention. METHOD: The study was conducted from 2017 to 2019 with a convenience sample of nursing students (N = 195). Data were collected at four timepoints with self-report questionnaires on spiritual health, health-promoting behaviors, resilience and the Beck Depression Inventory-II from 2017 to 2019. Three timepoints were collected during the fourth year of the student stage: fall semester (T1), spring semester (T2) and just prior to graduation (T3); the fourth timepoint was the novice stage (T4), after at least 3 months as a registered nurse. General estimating equations determined predictors of resilience. RESULTS: A total of 124 new nurses completed all questionnaires (63% response rate). Although mean scores fluctuated slightly during the student stage, the scores at T4 were significantly worse for spiritual health (Wald χ2 = 30.23, p < .001), health-promoting behaviors (Wald χ2 = 34.89, p < .001), depressive symptoms (Wald χ2 = 46.75, p < .001) and resilience (Wald χ2 = 21.54, p < .001). Spiritual health, health-promoting behaviors were positively correlated with resilience (p < .001); depressive symptoms were negatively correlated (p < .001). Controlling for the effect of time, resilience of novice nurses was positively associated with nursing school practicum grade, spiritual health and health-promoting behaviors (ß = 10.30, p < .001; ß = 12.14, p < .001; and ß = 14.62, p < .001, respectively) and negatively associated with depressive symptoms (ß = - 0.53, p < .001). CONCLUSIONS: Scores for all variables were similar over the three timepoints of the student stage. However, the significant changes at T4 compared with the student stage suggest the novice stage of nursing was challenging. Increasing resilience could reduce the challenges of transitioning to a hospital environment. Nursing educators and administrators could increase nursing students' resilience by restructuring the educational curricula. This could include helping nurses increase their spirituality and health-related behaviors and providing psychological support to reduce depressive symptoms. Increasing levels of resilience could reduce nurses' emotional stress and improve retention of new nurses.

A spiritual education course to enhance nursing students' spiritual competencies.

The study aimed to determine the impact of an elective spiritual education course for nursing students on spiritual competencies. A convenience sample of nursing students (N = 92) was recruited from a baccalaureate school of nursing between February and July 2016. The intervention group (n = 45) was comprised of students enrolled in the elective spiritual education course which integrated non-Christian Eastern cultural beliefs; the control group was comprised of students not enrolled in the elective (n = 47). A quasi-experimental design examined pretest, posttest, and follow-up data from students' self-administered questionnaires. The intervention effect of the course was analyzed using generalized estimation equation. The results indicated posttest scores among nursing students in the intervention group were significantly better than the comparison group for spiritual health. Practicum stress and professional commitment were significantly better at follow-up. Spiritual care attitudes, caring behavior, and religious belief were significantly improved from pretest to posttest, and at follow-up for the intervention group compared with the control group. In conclusion, a spiritual education course should be considered as a regular course in the nursing curriculum, which could improve students' spiritual competencies, individual spiritual growth, and the ability to care for patients.

Exploration of the Association Between Religious Affiliation and Attitude Toward Spiritual Care in Clinical Nurses.

BACKGROUND: Religion is an important cultural asset that is known to affect the thoughts, behaviors, and lifestyles of individuals. However, the impact of religious affiliation, religious activities, and religious beliefs on the attitudes of nurses toward providing spiritual care to their patients is an issue that has been inadequately explored. PURPOSES: The aim of this study was to explore the relationship between religion (including religious affiliation, religious activities, and religious beliefs) and attitude toward spiritual care in clinical nurses. METHODS: This study used a cross-sectional correlation study design. Six hundred nineteen nurses were included as participants. The measurements used included a questionnaire on religious affiliation, religious activities, and religious beliefs; the Spiritual Health Scale-Short Form; the Spiritual Care Attitude Scale; and a sociodemographic datasheet. The study employed hierarchical regression modeling to establish the relationships between the aspects and degrees of religious belief and practice as well as the attitudes of participants toward spiritual care. RESULTS: Most of the participants participated infrequently in religious activities. After controlling for demographic variables and spiritual health, religious belief was found to be an important factor impacting participants' attitudes toward providing spiritual care. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The findings indicate that religious belief is an important factor impacting the attitudes of nurses toward providing spiritual care and that the religious/spiritual beliefs of nurses may impact on their fitness to provide spiritual care to patients. Education on religion may be needed to improve the attitude of nurses toward providing spiritual care.

[The Impact of Demoralization on Spiritual Well-Being in Terminally Ill Patients].

BACKGROUND: Terminally ill patients often experience demoralization, which negatively impacts their spiritual well-being. However, studies on the relationship between demoralization and levels of spiritual well-being in Taiwan are still at an early stage. Thus, more research is required to verify and support the correlation between demoralization and spirituality and to establish methods to care for and treat demoralization. PURPOSE: The purposes of this study were to investigate the demoralization and spiritual-well-being status of terminally ill patients and to determine the value of demographic data, disease characteristics, demoralization in predicting spiritual well-being. METHODS: A cross-sectional research design was used to evaluate terminally ill patients who were currently receiving hospice care at a teaching hospital in southern Taiwan. Data were collected using a structured questionnaire that included a demographic datasheet and the Chinese demoralization and spiritual well-being scale. Pearson product-moment correlation and hierarchical multiple regression were performed to analyze the relationship between the target variables and spiritual well-being. RESULTS: Of the 82 participants surveyed, 81.7% had high levels of demoralization. The average spiritual well-being score for the participants was 31.7 (moderate). A significant and negative correlation was found between degree of demoralization and level of spiritual well-being (r = -.600, p < .01). Regression analysis showed that, after controlling for demographic characteristics, disease characteristics, and other variables, demoralization scores were shown to predict the spiritual-well-being score, explaining 12.7% of total variance (ß = -.41, p < .001). In other words, higher demoralization was associated with lower spiritual well-being. CONCLUSIONS: Demoralization is a common problem in people with terminal illnesses and is an important factor affecting spiritual well-being in this patient population. In clinical practice, early assessment and identification of demoralization in patients as well as establishing relevant models of care for demoralization are necessary to help patients attain spiritual well-being at the end of life.

Symptom clustering in patients with childhood-onset systemic lupus erythematosus.

AIMS: To: (a) explore the prevalence of the symptoms perceived by patients with childhood-onset systemic lupus erythematosus; (b) identify the symptom clusters occurring in patients with childhood-onset Systemic lupus erythematosus; and (c) examine the association of the burden of each symptom cluster with sleep quality and depression. BACKGROUND: Systemic lupus erythematosus is an inflammatory autoimmune disease that may result in patients' perception of various symptoms, with possible negative effects on their quality of life. Understanding the prevalence of symptoms perceived by childhood-onset Systemic lupus erythematosus patients and the disease's symptom clusters may be helpful in managing such burdensome symptoms. DESIGN: A correlational study design was used for this study in 2016. METHODS: Self-reported data from the Systemic lupus erythematosus symptom checklist were used to assess the symptoms perceived by patients. Symptom clusters were analysed using cluster analysis. RESULTS: Seventy-five patients were included in this study. The most prevalent and burdensome symptom perceived by patients was fatigue. Five clusters were derived, including symptoms related to pain and itching; bruises and stomach complaints; weight gain; body image and circulatory problems; and fatigue. A poor sleeper may perceive a greater symptom burden in all five of the symptom clusters, except for cluster #3, which refers to symptoms related to weight gain. CONCLUSION: Five symptom clusters were identified. It is hoped that this study will give useful knowledge for understanding the symptom clusters for patients with Systemic lupus erythematosus and for improving nursing care quality.

[The Spiritual Health Status and Spiritual Care Behaviors of Nurses in Intensive Care Units and Related Factors].

BACKGROUND: Patients suffer sudden and life-threatening conditions in intensive care units (ICU), which frequently result in traumatic changes in physical, mental, and spiritual health. Little research has been conducted on the spiritual health and spiritual care behaviors of nurses in ICU. PURPOSE: To explore the relationship among demographic characteristics, spiritual health, and spiritual care behaviors in ICU nurses. METHODS: A descriptive correlational research was used and 219 nurses from three teaching hospitals were enrolled as study participants. A structured questionnaire consisting of a demographic datasheet, a spiritual health scale, and a spiritual care behavior scale was used for data collection. SPSS for Windows version 22.0 was used for statistical analysis. RESULTS: The participants received few hours of spiritual-care education. The highest scored item for spiritual health was "connecting with people". The highest scored item for spiritual care behavior was "helping the patient out of adversity". Participants who were older in age and who had more years of clinical experience exhibited spiritual care behaviors such as "helping the patient out of adversity" and "retaining hope" more frequently with their ICU patients. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The older and more clinically experienced nurses in this study performed spiritual care behaviors at a higher frequency than their younger, less experienced counterparts. Therefore, it is recommended that hospitals retain more-experienced nursing staff to elevate the level of holistic health care. Concurrently, training in spiritual care skills should be provided to younger and less experienced nurses in order to facilitate more spiritual care behaviors. The results of this study provide a reference for providing spiritual care behaviors to patients.

Psychometric Testing of a Religious Belief Scale.

BACKGROUND: Nurses account for a significant percentage of staff in the healthcare system. The religious beliefs of nurses may affect their competence to provide spiritual care to patients. No reliable and valid instruments are currently available to measure the religious beliefs of nurses in Taiwan. PURPOSES: The aims of this study were to develop a religious belief scale (RBS) for Taiwanese nurses and to evaluate the psychometric properties of this scale. METHODS: A cross-sectional study design was used, and 24 RBS items were generated from in-depth interviews, a literature review, and expert recommendations. The RBS self-administered questionnaire was provided to 619 clinical nurses, who were recruited from two medical centers and one local hospital in Taiwan during 2011-2012. A calibration sample was used to explore the factor structure, whereas a validation sample was used to validate the factor structure that was constructed by the calibration sample. Known-group validity and criterion-related validity were also assessed. RESULTS: An exploratory factor analysis resulted in an 18-item RBS with four factors, including "religious effects," "divine," "religious query," and "religious stress." A confirmatory factor analysis recommended the deletion of one item, resulting in a final RBS of 17 items. The convergent validity and discriminate validity of the RBS were acceptable. The RBS correlated positively with spiritual health and supported concurrent validity. The known-group validity was supported by showing that the mean RBS between nurses with or without religious affiliation was significant. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The 17-item RBS developed in this study is a reliable, valid, and useful scale for measuring the religious beliefs of nurses in Taiwan. This scale may help measure the religious beliefs of nurses and elicit the relationship between these beliefs and spirituality.

Elders' Experiences During Return Visits to the Emergency Department: A Phenomenographic Study in Taiwan.

BACKGROUND: Elders often experience multiple chronic diseases associated with frequent early return visits to emergency departments (EDs). There is limited knowledge of the experiences and concerns of elders during ED return visits. OBJECTIVES: The purpose of the research was to explore the experiences of elders during ED return visits, with a view toward identifying factors that contribute to return visits. METHODS: The qualitative approach of phenomenography was used. Data were collected at one ED in a 3,000-bed medical center in Taiwan. Inclusion criteria were aged 65 or above and return visits to the ED within 72 hours of discharge from an index ED visit. The seven steps of qualitative data analysis for a phenomenographic study were employed to develop understanding of participants' experiences. RESULTS: Thirty return-visit elders were interviewed in 2014. Four categories of description were established from the participants' accounts. These were "being tricked by ED staff," "doctor shopping," "a sign of impending death," and "feeling fatalistic." The outcome space of elders with early return visits to ED was characterized as "seeking the answer." CONCLUSION: Index ED visits are linked to return visits for Taiwanese elders through physiological, psychological, and social factors.

Workplace violence against emergency nurses in Taiwan: A phenomenographic study.

BACKGROUND: Workplace violence (WPV) is a serious problem in health care in Taiwan, as it is worldwide. Among all nursing staff, emergency department (ED) nurses are at the highest risk of WPV; yet, little attention has been paid to nurses as WPV victims. PURPOSE: The purpose of the study was to understand ED nurses' WPV experiences and perspectives. METHODS: An interpretive qualitative phenomenographic design was used to answer the following research question: what are the qualitatively different ways in which nurses in Taiwan experience WPV in the ED? Thirty ED nurses who identified as experienced with WPV were interviewed, and phenomenographic analysis was used to assess the data. FINDINGS: Four categories of description emerged. WPV was seen as a continuing nightmare, a part of daily life, and a direct threat, and it had a negative impact on nurses' passion for emergency care. WPV adversely affected nurses on physical, psychological, social, personal, and professional levels. CONCLUSION: The findings of this study have practical implications for in-service WPV training programs and may be used to inform potential changes to policy and legislation designed to establish a safer ED environment for staff.

Family needs of critically ill patients in the emergency department.

INTRODUCTION: Family members' experience a range of physiological, psychological and emotional impacts when accompanying a critically ill relative in the emergency department. Family needs are influenced by their culture and the context of care, and accurate clinician understanding of these needs is essential for patient- and family-centered care delivery. The aim of this study was to describe the needs of Taiwanese family members accompanying critically ill patients in the emergency department while waiting for an inpatient bed and compare these to the perceptions of emergency nurses. METHODS: A prospective cross-sectional survey was conducted in a large medical center in Taiwan. Data were collected from 150 family members and 150 emergency nurses who completed a Chinese version of the Critical Care Family Needs Inventory. RESULTS: Family members ranked needs related to 'communication with family members,' as most important, followed by 'family member participation in emergency department care', 'family member support' and 'organizational comfort'; rankings were similar to those of emergency nurses. Compared to nurses, family members reported higher scores for the importance of needs related to 'communication with family members' and 'family members' participation in emergency department care'. CONCLUSIONS: Family members place greater importance than emergency nurses on the need for effective communication.

Waiting and hoping: a phenomenographic study of the experiences of boarded patients in the emergency department.

AIMS AND OBJECTIVES: To understand the experiences and concerns of patients in the emergency department during inpatient boarding. BACKGROUND: Boarding in the emergency department is an increasingly common phenomenon worldwide. Emergency department staff, patients and their families become more stressed as the duration of boarding in the emergency department increases. Yet, there is limited knowledge of the experiences and concerns of boarded patients. DESIGN: The qualitative approach of phenomenography was used in the study. METHODS: The phenomenographic study was conducted in one emergency department that treats approximately 15,000 patients each month. Twenty emergency department boarding patients were recruited between July-September 2014. Semi-structured interviews were used for data collection. The seven steps of qualitative data analysis for a phenomenographic study - familiarisation, articulation, condensation, grouping, comparison, labelling and contrasting - were employed to develop an understanding of participants' experiences and concerns during their inpatient boarding in the emergency department. RESULTS: The perceptions that emerged from the data were collected into four categories of description of the phenomenon of emergency department boarding patients: a helpless choice; loyalty to specific hospitals and doctors; an inevitable challenge of life; and distrust of the healthcare system. The outcome space for the emergency department boarding patients was waiting and hoping for a cure. CONCLUSION: The experiences and concerns of emergency department boarding patients include physical, psychological, spiritual and health system dimensions. It is necessary to develop an integrated model of care for these patients. RELEVANCE TO CLINICAL PRACTICE: Understanding the experiences and concerns of patients who are placed on boarding status in the ED will help emergency healthcare professionals to improve the quality of emergency care. There is a need to develop a care model and associated intervention measures for emergency department patients during the boarding process. The results of this study will help health regulatory authorities to develop an appropriate emergency department boarding system so that patients receive better emergency care.

Predictors of Hospital Nurses' Safety Practices: Work Environment, Workload, Job Satisfaction, and Error Reporting.

Nurses' safety practices of medication administration, prevention of falls and unplanned extubations, and handover are essentials to patient safety. This study explored the prediction between such safety practices and work environment factors, workload, job satisfaction, and error-reporting culture of 1429 Taiwanese nurses. Nurses' job satisfaction, error-reporting culture, and one environmental factor of nursing quality were found to be major predictors of safety practices. The other environment factors related to professional development and participation in hospital affairs and nurses' workload had limited predictive effects on the safety practices. Increasing nurses' attention to patient safety by improving these predictors is recommended.

An exploratory factor analysis for developing and validating a scale of Nursing Students Competence Instrument.

BACKGROUND: Nursing competency is a standard component of the nursing curriculum in baccalaureate nursing education in Taiwan. However, limited studies have been found on the development of a measurement for assessing Taiwanese baccalaureate-level nursing competency. OBJECTIVE: The aim of this study was to develop and validate a Nursing Students Competence Instrument (NSCI) for Taiwanese baccalaureate-level nursing students. DESIGN: The items of this newly developed scale were derived from a previous published qualitative study by the authors. Validity and reliability of the instruments were assessed with exploratory factor analysis. In considering external validity and homogenous characteristics, data were collected from two periods of time: February 2011 and 2012. SETTING: Four hundreds nursing students enrolled in the 2-year baccalaureate-level at the study university in Taiwan were invited to participate in the study. PARTICIPANTS: Two hundreds and nine nursing students in the 2-year baccalaureate-level program were recruited. METHODS: Descriptive statistics and exploratory factor analysis were used to determine validity of the instrument. Cronbach alpha, split-half coefficients and item analysis verified the reliability of instrument. RESULTS: Significant levels of reliability and validity for the newly developed Nursing Student Competency Instrument were found. The competency instrument comprised four dimensions with 27 items for graduates to meet to determine their nursing competency. Four factors were analyzed and categorized as integrating care abilities, leading humanity concerns, advancing career talents, and dealing with tension, and explained 22.29%, 18.59%, 15.99% and 11.23% of total variance, respectively; these four explained 68.09% of the total variance. CONCLUSIONS: Results support validation of the new nursing competence assessment scale for Taiwanese nursing students at baccalaureate levels. The authors recommend that the NSCI could be applied in the nursing schools to evaluate the learning outcomes of nursing students' competence.

The impact of nurses' spiritual health on their attitudes toward spiritual care, professional commitment, and caring.

BACKGROUND: The personal spiritual health of nurses may play an important role in improving their attitudes toward spiritual care and their professional commitment and caring capabilities. PURPOSE: The purpose of this study was to explore the impact of nurses' personal spiritual health on their attitudes toward spiritual care, professional commitment, and caring. METHODS: A total of 619 clinical nurses were included in this cross-sectional survey. The measurements included the spiritual health scale-short form, the spiritual care attitude scale, the nurses' professional commitment scale, and the caring behaviors scale. Structural equation modeling was used to establish associations between the main research variables. RESULTS: The hypothetical model provided a good fit with the data. Nurses' spiritual health had a positive effect on nurses' professional commitment and caring. Nurses' attitudes toward spiritual care could therefore mediate their personal spiritual health, professional commitment, and caring. CONCLUSIONS: The findings indicated that nurses' personal spiritual health is an important value and belief system and can influence their attitudes toward spiritual care, professional commitment, and caring.

[The Design Requirements for an E-Health Management Platform: Addressing the Needs of Adolescent Girls at High Risk of Metabolic Syndrome].

BACKGROUND: The rising prevalence of metabolic syndrome among adolescents has not been effectively addressed by current campus-based health promotions. Using the Internet in these promotions may help health professionals achieve better healthcare management. PURPOSE: The purpose of the present study was to explore the design requirements of an e-health management platform from the subjective perspective of adolescent girls who were at a high risk of metabolic syndrome. The findings may provide a reference for designing nursing interventions that more effectively promote healthly lifestyle habits to adolescents. METHODS: This qualitative study employed a snowball approach and used a semi-structured interview guide to collect data. A total of 20 Taiwanese adolescent females who were at a high risk of metabolic syndrome, aged 16-20 years, able to speak Mandarin or Taiwanese, and willing to participate and to have their sessions tape-recorded were enrolled as participants and engaged individually in in-depth interviews. The constant comparative method was used to inductively analyze the interview data. RESULTS: Five main themes related to the e-health management platform emerged from the data. These themes included: an attractive and user-friendly website interface, access to reliable information and resources, provision of tailored health information, access to peer support, and self-monitoring and learning tools. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The findings highlight the key design needs of an e-Health management platform from the perspective of adolescent girls who are at a high risk of metabolic syndrome. The identified themes may be addressed in future revisions / developments of these platforms in order to better address the needs of this vulnerable population and to effectively reduce the incidence of metabolic syndrome. The authors hope that the results of the present study may be used to provide better healthcare and support for adolescent girls with metabolic syndrome.